Cost-effective prevention of cardiovascular disease (CVD) is necessary to avert significant suffering and death in developing countries. The purpose of this International Research Scientist Development Award is to prepare the applicant, Thomas A Gaziano, for a career as an independent investigator in cost-effective CVD prevention in developing countries. Current international guidelines assess risk of CVD on the basis of multiple risk factors including cholesterol and diabetes status. However, the cost of blood testing and a lack of trained staff to obtain samples make these guidelines unsustainable in developing countries. Further, it is unclear how much added information blood sampling provides to other easily obtainable risk factors. Dr. Gaziano proposes a three-year training and research proposal to continue the development of a simple bloodless screening tool for predicting those at highest risk for CVD and then to assess the cost effectiveness of such a strategy in two very different developing countries. The research plan consists of two specific aims. 1. To assess the predictive value of a set of easily obtainable risk factors for CVD --age, tobacco, systolic blood pressure, and an obesity measure (BMI)~ and compare it to the more commonly used model that uses age, tobacco status, blood pressure, lipids and diabetes status. The analysis will be conducted with the Women's Health Study and Physician's Health databases using Cox-proportional hazard modeling. 2. To conduct a cost-effective analysis of screening for CVD using the following strategies: screening without blood sampling, screening with blood sampling, and a third strategy of a two step process of first assessing risk with no blood testing to identify a subset of the population who might benefit from higher cost screening with blood testing. This analysis will be based in part on cost and risk factor prevalence data in the Sentinel Surveillance for CVD in India Study and the Demographic and Health Survey in South Africa. PUBLIC HEALTH RELEVANCE: Eighty percent of cardiovascular deaths occur in developing countries. Assessing those at high risk is an important strategy for prevention. Developing countries have limited resources for strategies that require laboratory testing. We conducted a study to determine if a non laboratory-based risk prediction tool could perform as well as one requiring laboratory information.